Are Budget Cuts Endangering Physician Training?

One of the great challenges of implementing health reform is training a health care workforce that is well-prepared to meet the needs of the estimated 30 million Americans who will soon be added to the rolls of the insured. To help with that, Medicare subsidizes academic medical centers and teaching hospitals for a portion of the costs of training new doctors.

The nation’s current deficit woes are jeopardizing that funding, according to Herbert Pardes, M.D., former director of the National Institute of Mental Health and now president and CEO of New York-Presbyterian Hospital, and Edward D. Miller, M.D., dean and CEO of Johns Hopkins Medicine. They write in an op-ed in yesterday’s Wall Street Journal,

Seeking to reduce the federal budget, Democratic and Republican lawmakers are looking at cutting funds for graduate medical education. Specifically, they're considering reducing the Medicare reimbursement for doctor training, possibly in half, to cut about $4 billion from the federal budget. This could dramatically limit the ability of patients to see physicians, even for critical illnesses….

As a part of Medicare, graduate medical education reimburses academic medical centers and teaching hospitals for about a third of the direct costs associated with training the next generation of doctors, including salaries, malpractice insurance, equipment, and the extra time necessary for senior doctors to teach procedures to new doctors. Some of the indirect costs of training are also reimbursed, including specialized standby capacity like burn treatment and intensive care.

Even now, not enough doctors are being trained. And population trends, coupled with the expansion of health insurance, indicate that funding for graduate medical education should be increased. If funding is cut, it will reduce the number of well-trained doctors at the very time demand for more doctors is growing.

The result for patients? Longer waits, from the parent seeking a "well baby" visit to the recipient of a new pacemaker needing follow-up care.

What do you think of their argument? Where do you come down on deficit-cutting vs. doctor-training? Leave a comment below to share your thoughts.